[Question #1433] Follow Up Question on Rash

53 months ago
Hi, Doctor. This is a follow up to question #1385. I wouldn't be posting this follow-up except for two reasons: first, this occasion is the only time I'm been unfaithful in 20 years. Second, I have this rash that is concerning me related to the first. At first I though it was a heat rash but two (maybe three) weeks ago I noticed what looked like little bumps in the rash. They look almost like goose bumps but a little more pronounced. They don't look like they have any liquid in them, and I certainly wouldn't say they look like blisters (definitely no clear liquid). Depending on the light, they sometimes look like they have little white heads but it's hard to tell. I was worried about HSV-1 or 2 but I had a test at almost 7 weeks that showed I had neither. I also read sometimes HSV IIG tests aren't that accurate, but the timing seems all wrong for herpes (5-6 weeks after exposure). The bumps don't hurt even with direct touch, they haven't changed at all in the 2-3 weeks since I noticed them. I have this tingly burning (almost like Icy Hot feeling on the top of my thighs and inner thigh around my knees. Does this sound crazy? Any thoughts on what this might be?
53 months ago
I forgot a key part, the location. The rash is on my inner thighs (left and right) where legs and scrotum meet. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome back. I'll be taking your question this time. I reviewed your recent discussion with Dr. Hook.

You don't say where on your body you are experiencing this "rash". I put it in quotes because apparently it is subtle and I'm not convinced it's new or abnormal. In any case, for sure it isn't herpes, which doesn't behave at all like this, either in its appearance of its unchanging nature over a couple of weeks. I see no reason to assume it is related in any way to the low risk sexual exposure you described in your other thread. Also, there is no STD that could cause the sensations you describe for your thighs, knees, etc. Herpes also never does anything like this. On the other hand, they are quite typical for the sensations described by many people with anxieties about regretted or uncertain sexual exposures. (This forum alone probably fields an average of 20 questions a month that incluce such symptoms, always emotionally based as best we can tell.) And I also have to suspect your anxieties are affecting your assessment of your "rash". 

I would advse seeing a physician if any of these symptoms continue or you remain uncertain about them. But from all you say above and in your other thread, I am confident they are not due to any STD or other infection from the exposure several weeks ago. If related to that event, the emotional connection almost certainly is the right one.

Best wishes--  HHH, MD

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53 months ago
Thanks so much. I'm sure most (all?) of this is emotional/psychological and I have an appointment with a therapist next week to go over this (and some other things). I call it a a rash because, as I mentioned in my thread with Dr. Hook, it initially reminded me of a heat rash. It was a slight rash that itched and burned a little in the left and right crevices of my inner thighs where they meet the scrotum. It then spread, a tiny bit, to the inner thighs and the bumps I mentioned showed up on my left and right inner thighs right below that crevice.  Right now the skin is only slightly red where the bumps are but it is redder than the surrounding skin. Unfortunately, I turned to medical advice from Dr. Google who is a horrible physician and takes more pleasure in messing with your head than providing any really insightful info, and now think it could also be Moluscum (except there's no dimples). Does that sound probable from what I described. There are two final things I forgot in this new post. I'll share them to see if they change your opinion, then I'll take this up in the future only with my therapist. First, about the time I noticed the bumps, my scrotum was burning and itching real badly (has gone away since). I thought it looked much redder too but that may have been only psychological. Second, I noticed what looks like fordyce spots on the right side shaft where it meets my body. The spots haven't changed since I noticed them probably a week ago (they may have been there before and I'm just really freaking out but I don't think so). Does that change your opinion at all? Oh, and do you agree that the tests I took would be conclusive at 6 weeks 5 days or should I follow-up (especially herpes)?  For some reason the thought of untreatable things like HSV-1 and 2 really freak me out (I know there was no risk for HIV).Thank you so much Dr. Handsfield.
53 months ago
Dr. Handsfield, did you get my follow-up question?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Sorry I didn't get to this sooner.

With your more detailed description, I remain confident your rash is nothing serious, for sure not an STD, and (still) maybe nothing abnormal at all. Neither herpes nor any other STD causes reddened or itching scrotal skin; this is commonly due to moisture, superficial irritation related to hygiene, or sometimes jock itch or other minor skin infections -- but for sure no STD does this. Similarly, unchanging skin spots of the sort you describe also do not suggest herpes or any other STD.

Should you be tested for herpes? Based on your symptoms and all the other information, I would recommend against it. However, if you remain unconvinced and/or need the additional reassurance, you could have a blood test 3 months following the exposure. I would expect a negative result for HSV2. Of course half of all adults in the US (more or less in other countries) have positive HSV1 tests, so be prepared for that possibility. Also, 10-20% with no known genital herpes are positive for HSV2, so that also could be positive. If so, it will not explain your symptoms, but if negative it would add to the already strong evidence your problem isn't herpes. So if you decide to be tested, be prepared for the possible uncertainties that could result. Putting it in personal terms, if somehow I were in your position I definitely would not do it. No matter what the result, it won't explain your symptoms.

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53 months ago
Thanks so much Dr. I saw my GP, she said it was a yeast infection. She gave me a prescription cream and three tabs of Fluconazole. She said it definitely wasn't herpes so stop worrying about it. With regards to re-testing, I completely understand your point. I'm guessing the iGg test I had for HSV-1 and HSV-2  6 weeks 5 days after the incident only told me that I was negative for both before this encounter and I still may have contacted either. Is that a correct way to look at it? Both you and Dr. Hook use terms like "low risk", and "infections from the exposure you describe is tiny" and I guess I was wondering if you could translate that into a rough 1 in X or X% chance of acquiring STIs (even an educated guess) from a single insertive oral encounter? I know symptoms don't have to be present, but do lack of symptoms on the parter decrease the probability at all? Thanks so much for you help, I'll await your answers and you closing the thread.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Glad to hear a specific diagnosis has been reached.

I'd forgotten you had already has the HSV blood test. That result indeed showed you were not infected with HSV2 before the encounter, and probably not during it. Although it takes up to 3 months, about 80% of newly infected people have positive results by 6 weeks. You probably didn't catch HSV1 either, but the test misses some HSV1 infections. But the combination of no herpes symptoms, plus negative test, plus apparently no obvious oral herpes in your partner (see below) add up to near certainty.

All in all, oral sex can be considered safe sex, with low risk for all STDs and zero risk for some. Almost impossible to catch HSV2, but HSV1 is among the more common of the rare infections. HIV: no proved infections ever, mouth to penis. Gonorrhea slight, chlamydia almost zero. All in all, probably less than 1 chance in 1,000 for all infections for any single encounter, maybe as low as i in 10,000. And lack of symptoms in the oral partner, especially of absence of an obvious oral herpes outbreak, indicates little or no risk for HSV1.

So for sure it's time for you to move on. Cancel my previous comments about considering another HSV IgG test at 3 months. No need and no point to it.

That completes this thread. Best wishes and stay safe. Also, let's make this the last post on this exposure and your symptoms, OK? We strongly discourage repetative questions on the same subject. You can go forward with confidence that you don't have herpes or any other STD from the encounter.

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